Tuesday, 22 April 2008

This GP thing

I want to mention a few compliments I've had recently. I'm a bit reluctant to keep listing these because it looks as though I am blowing my own trumpet. In fact I know that I am not an excellent GP. I do not “strive for excellence” because I hate that weasel phrase, I just try to be “good enough”. I am a bog standard GP. But GPs are getting a bad press at present which appears to be engineered by Her Majesty's Government. I mention these compliments because they show what some of Her Majesty's subjects think of one of Her bog standard GPs.

Two patients have spontaneously expressed the hope that I am not going to retire soon. One is a delightfully twittery and slightly anxious elderly lady who has much to be anxious about. “Don't retire, will you. It gives me confidence that you're there” said she. The other is a younger woman who has suffered from quite severe mental health problems for more than a decade. “You're not thinking of retiring are you? I don't know what I'd do without you here.” I found this a little odd at first, because nowadays I only see her about once a year and her mental health problems are mostly sorted out by the secondary care services. Yet I saw her a lot in the early days when her illness was developing and we formed some sort of bond which still persists.

I don't know why they should both suddenly fear that I am going to retire soon. (In fact that is my intention, for personal reasons as well as being completely hacked off by Her Majesty's Government and the burgeoning and choking hand of regulation. But only a few people know about it.) Perhaps I look older than my years - losing my hair certainly hasn't helped, and I observe with a tinge of sadness that most of my good looking young female patients evidently see me more as a kindly elderly relative than a possible sexual predator. Or perhaps news that GPs are generally demoralised is spreading?

Then today I was given a compliment that really pleased me, by a junior hospital doctor. A few weeks ago he came to see me for the first time with symptoms suggestive of inflammatory bowel disease. It was the first time he had seen a GP for years and he was a bit embarrassed, particularly as he had been ignoring the symptoms for some time. I think that doctors deserve good treatment from their colleagues, so I was at pains to reassure him that he had nothing to be embarrassed about. I arranged the appropriate blood tests and referral, and gave him some treatment immediately because it's hard being a junior hospital doctor when you are constantly having to run to the toilet. And I gave him some treatment for a skin condition which he had also been ignoring. When I saw him again today I learned that the hospital investigation had confirmed the diagnosis, that his symptoms had cleared up almost immediately after starting my treatment, and that he was feeling better than he had for a long time. I asked how his skin condition was doing, and a smile appeared on his face. “Hey, this GP thing really works” he said, “that's better too!”

Yes ladies and gentlemen, this GP thing really works, though the Government doesn't think so. A GP (rather than a Health Care Professional with a Protocol) can assess, diagnose, treat and refer in an efficient manner tailored to the needs of the patient. And a GP can provide a supportive long-term personal service which is highly valued by vulnerable patients. We do lots of other good things as well: efficient prescribing and use of NHS resources, health promotion and screening, absorbing and coping with a vast amount of uncertainty, and filling in the gaps between the different contract-driven NHS services. And other things I'm not clever enough to think of just now. So why does the Government run smear campaigns against us, force us to work extra hours when we are exhausted while cutting our profits yet again, evidently intend our profits to continue to fall for years to come, and want to replace us by cheap inexperienced sessional doctors and Health Care Professionals in polyclinics? It may be that Joni Mitchell was correct: “don't it always seem to go that you don't know what you've got 'til it's gone”.

The NHS has got me for another two years, then I'm off in my big yellow taxi.


Anonymous said...

I'd have thought you'd know better by now. You're not supposed to be a good GP, you're supposed to meet targets. Being competent has nothing to do with it, you're not supposed to use your training or experience, just tick boxes. Heavens, then next thing you'll be telling us is that you don't want to work for a big corporation in a nurse-led polyclinic!

Phyllis Hunt McGowan said...

When I find a new blog that I like, I at times don't know which post to comment on. My reason for liking it overall is not just the very fine writing, but the fact that you're a doctor who cares. I'm an immigrant from Ireland living in the US and I've found more compassion in your posts than in the heart of any doctor I've met here.
My husband was very sick in November. He went to the doctor in great pain; the doctor mechanically suggested a CAT scan at the ER. My husband wasn't sure why that was necessary and asked a few questions which didn't go down very well. The doctor said that if he didn't want to go to the ER he didn't have to; he could just go home. "I'm just trying to find out what your goals are," the doctor said. He was so cold, I felt like crying. So did my husband. We spent eight hours between doctor and ER that day and not one single person gave us comfort all the day long. I know, of course there are millions of stories like ours and much worse but so few blog posts from the perspective of someone like yourself. We're looking for a better doctor now, and I hope in our travels we meet somebody who cares even a fraction of how much you do.

Jobbing Doctor said...

Dear Andrew,

I always visit your site because you write eloquently about the world that I inhabit.

I do think it is really important that you (and I( continue to write about what we value and cherish to counter the febrile antagonism from the authorities.

I wish I could write like you.


eryn said...

Dr Brown,
I like it when your blog makes me smile ;-p. I hope i can be a good enough doctor also.

take care,

Anonymous said...

See - when I posted my comment the other day it was because I suspected there were people who know you as a "real" GP person also pick up on what we hear from your blog. You care, and because you care you suffer the agonies of being caring. I agree with nutty - this government thinks that a "health care professional" paid £10 an hour with a questionnaire can give the same result as you at what is, you have to admit, apparently a large multiple of £10 per hour (I only say that because I know what my husband's rate is when selling his services to agencies outside the hospital). It's not quite the same, but there are parallels: I'm a translator and have a constant fight to get paid a reasonable rate too - there's always someone who will offer to do the job cheaper. They've done an intensive English course, of course they can do it. BUT - do they get the right answer, and how long does it take them? How many attempts will it take. Everyone has a foreign-made bit of equipment in their house whose "book of destructions" is meaningless. And in my opinion - I don't mind that for my refigerator, washing machine or food mixer. But heck - I do prefer my "health care professional" not to have to keep trying to get it right - because when it is something really nasty I might be dead before they've tried all the options!
Keep caring, nil illegitmum carborundum (or words to that effect!)

Anonymous said...

It was the good Dr Crippen who saved my daughter from the idiot idea of doing a medical degree. We were lucky: back then he blogged in a font large enough for me to be able to read it.

Fiona said...

You sound like my GP (and it took me 26 years to find her and I'm clinging like a limpet!) and the kind that shouldn't be lost due to bureaucracy.

Anonymous said...

"Yes ladies and gentlemen, this GP thing really works, though the Government doesn't think so."

Because this F*ing government is F*ing useless and trying to shift the blame.

Apologies for descending to Dr Rant levels but it tends to happen every time I think of this F*ing government.

Anonymous said...

This Government, that I used to be a supporter of and party member, has a lot to answer for. Not just with the NHS, but just about everything they've done past 1999 (and yes I did mean 1999 as the first 18 months or so went pretty well and they did lots of nice things that actually helped)

Anonymous said...

Very interesting post. Just wondering; would you encourage your children to follow careers in medicine?

Anonymous said...

You forgot the net line of Joni's song, Andrew. As an updated version, how about:

"...they paved the parking lot, and put up a polyclinic"

Anonymous said...

I've got another re-write for Joni's masterpiece.

"They took all the GPs
And put 'em in a GP museum
And charged everybody
Fifty quid a time just to see 'em"

I think we could be onto something here. I smell a hit.

Anonymous said...

dearieme said...
It was the good Dr Crippen who saved my daughter from the idiot idea of doing a medical degree. We were lucky: back then he blogged in a font large enough for me to be able to read it.

23 April 2008 16:07


Oh dear,dearieme, I don't know how to change my font and spacing, and my DK technocrat is in love at the moment!


PS Sorry to have to reply here!

Anonymous said...

I fear all we blogging GPs are of er.. "a certain age" - I too can recite most of Joni's early work.

I introduced my children to her. They seem suprised that there was good music from my era. They don't seem to realise that we invented it!


Dr Andrew Brown said...

I was quite pleased with this post after I had written it, so I'm glad to see that it has attracted a lot of comment.

Nutty: cynicism will get you nowhere, you know. ;-)

TheElementary: Thank you for your compliment and your story. All doctors have "bad days", so perhaps that doctor wasn't as bad as he appeared. In any case, I hope that things improve for you.

JD, Eryn & Fi: You are very kind. Thank you.

Anonymous: As you say, we are all facing a common problem. Thanks for your support.

Dearieme: Have you met my friend, the Fortunate Optician? :-)

Old Codger & Oliver Smith: Do I agree with you? You might think so, but I couldn't possibly comment. :-)

Anonymous: I have never tried to influence my children's choice of study or career, I have only tried to support them in what they want to do. I know it looks as though I am applying for The Most Irritatingly Wonderful Man Award, but I simply wanted to avoid being criticised for pushing them into a career that they didn't want. And (having seen how grumpy and stressed it has made me) they have avoided medicine like the plague. If that isn't a mixed metaphor.

Dr Aust: Ah, Joni Mitchell - what a great musician she is! For me, the apotheosis of her work is "Hejira". It would definitely be one of my Desert Island Discs.

Dr John Crippen: Lovely to have you commenting on my blog. The praise of the praiseworthy, and all that. As usual, my visit statistics go through the roof whenever I am mentioned on the BritMeds. I don't know whether my partners (or my patients) would recognise me as "surely the kindest family doc in the country". The "persona" of the author is not necessarily the author himself. But I'm glad that my story holds water!

fwidman said...

Compliments, especially when one is in a job that is seen as less than wonderful,are always nice :)
It seems like you do a great job, so it is no wonder that people are hoping that you do not retire soon.
And, yes, Joni was correct, unfortunately people do not know what they have until it is gone.

Dr Andrew Brown said...

Fwidman: Thanks. I'm sure you're right - we should appreciate and make the best of what we've got while it lasts. While doing our best to preserve the good things, of course.